NEWS
JUNE 2017
NOTES FROM THE CHAIR Enlightening Tomorrow’s Leaders We will recruit, develop, train, and deploy the best leaders in the world.
In our daily work we will have the opportunity to exemplify these core values and to further our vision.
Daring to be Exceptional We will amaze from all levels of our organization. Exceeding standards is not enough; we will pioneer new frontiers in excellence.
As many of you know the Department has been working on the development of our Vision, Mission and Core Values. I’m pleased to let you know that, as a group, we have developed the following. Our vision to “Improve Every Life” means we will make a positive contribution to every person’s life. Through care, curing, compassion and hope, we will improve the lives of our patients, their families, our department team members, our community, and the world.
This vision will be carried out through the following missions: Innovating Surgical Care Through a constant pursuit of excellence and a relentless drive to push the boundaries of surgical care, we speed healing, reduce suffering, and create hope. Curing through Discovery With an operation, we heal one person; with a new discovery, we can heal thousands. We will relentlessly search for the next cure, and once found we will search for the next.
As we work towards realizing our vision within these missions; we have identified the following core values:
First Annual Sarah V. and Ernest E. Moore Lectureship
2-3 Welcome New Faculty & Staff 3
Dr. Kovacs Honored
4-5 Graduation 6
2017 Annual Research Symposium
As you read through this newsletter you will see some of the ways we are already accomplishing our vision to:
It continues to be my privilege to share our successes and upcoming events with you. I hope you enjoy the newsletter that follows.
Compassion Dedication Innovation Excellence Diversity
Richard D. Schulick, MD, MBA The Aragón/Gonzalez-Gíustí Chair Professor & Chair
Teamwork Leadership Integrity These words embody the traits we want to encourage throughout our Department. As members of the Department we are the drivers behind the realization of this vision.
IN THIS ISSUE: 2
It is my hope that as a Department we will find ways to improve processes and strive for excellence in all that we do.
www.cusurgery.com 7
H. James Fox Lectureship
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Honors, Awards, Accomplishments
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SMASH5 - Mt. Democrat
8-9 Cancer Surgery through Keyholes 10
11 12-13 14 14-15
The Villain: A Cardboard Box
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E-Cigarette Battery Explosion Altruistic Donor - Paired Kidney Exchange Million Dollar Grant - STEM Couple, Gains from Loss Upcoming Events Page 1
WELCOME NEW FACULTY & STAFF! Faculty
Gretchen Ahrendt, MD Professor Surgical Oncology
Steven Ahrendt, MD Professor Surgical Oncology
Rachel Anthony, CPNP Instructor Pediatric Surgery
Adriana Behr, CPNP Instructor Urology
John Dodge, PAC Instructor Urology
Lindsay Dyer-Kindy, PAC Instructor Transplant Surgery
Rachel Hoon, PAC Instructor Transplant Surgery
Thomas Inge, MD Professor Pediatric Surgery
Colin Jenks PRA Transplant Surgery
Margaret Mazzarello Instructor GI, Trauma & Endocrine Surgery
Taylor McGraw, NP Instructor Pediatric Surgery
Jay Pal, MD Associate Professor Cardiothoracic Surgery
FIRST ANNUAL SARAH V. AND ERNEST E. MOORE TRAUMA LECTURESHIP Dr. Maier attended the University of Notre Dame for his undergraduate studies and received his medical degree from Duke University. He did his general surgery residency at the University of Washington and a research fellowship in Immunopathology at Scripps Clinic and Research Foundation. Ronald V. Maier, MD
We were honored to host Ronald V. Maier, MD as the First Annual Sarah V. and Ernest E. Moore Trauma Lectureship Visiting Professor and moderator of the Fourth Annual Department of Surgery Research Symposium. Dr. Maier is the Vice Chairman in the Department of Surgery at the University of Washington, as well as the Jane and Donald D. Trunkey Endowed Chair in Trauma Surgery. Dr. Maier is Surgeon-in-Chief at Harborview Medical Center in Seattle, Washington and the current President of the American Surgical Association.
Dr. Maier has been a PI or CoPI on several RO1 and K08 NIH grants as well as CDC grants over the last 30 years. He is author of approximately 360 peer-reviewed publications and nearly 70 book chapters. He has been honored with awards for excellence in teaching and research throughout his career and he continues to serve as a mentor to surgeons and researchers in training. We found Dr. Maier’s presentation on the “Response to Injury and Stress: A Genomic Storm” fascinating. It is easy to see how this research has the potential to change how we view and define Trauma in the future.
Elise Shellenberger, PAC Instructor Pediatric Surgery
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NEWS Staff
Whitney Carter Finance & Accounting Sr. Professional Finance & Administration
Audra Gray Business Support Specialist III Transplant Surgery
Patricia Knox Patient Affairs Coordinator GI, Trauma & Endocrine Surgery
Jonathan Radin, MBA Director of Clinical Strategy & Program Development Finance & Administration
ELIZABETH J. KOVACS, PHD ELECTED PRESIDENT ELECT OF SHOCK SOCIETY
Elizabeth Kovacs, PhD
The Shock Society was founded to facilitate the integration of basic and clinical disciplines in the study of the pathophysiology and treatment of trauma and shock and to promote an awareness of its national and international health importance. To accomplish this goal, the SOCIETY promotes original basic and clinical research in molecular, cellular, and systemic pathobiological aspects of shock and trauma and aims to develop new and important therapeutic approaches.
American Geriatrics Society, and Nature Immunology. She has mentored more than 100 trainees in her laboratory ranging from high school students to visiting professors. The majority of trainees have been graduate students in the PhD and MD/PhD tracks and PhD postdoctoral fellows, along with a handful of surgical residents. She serves or has served as the sponsor/cosponsor of a dozen NIH-funded National Research Service Awards (F30, F31 and F32) grants and Mentor Clinician Scientist Career Development K23 grants. She has served on numerous NIH Study Sections and was the President of the
Colorado Pulmonary-Alcohol Research Consortium and the Mucosal Inflammation Program. She received her PhD from the University of Vermont and completed a Postdoctoral Fellowship in Immunoregulation, Biological Response Modifiers Program at the National Cancer Institute, National Institutes of Health and an Executive Leadership Fellowship in Academic Medicine (ELAM) Program for Women at Drexel University before joining the faculty of Loyola University Chicago Stritch School of Medicine as an Assistant Professor. At Loyola, she was Professor and Vice Chair of Research in the Department of Surgery and CoDirector of the Burn & Shock Trauma Research Institute. She was also Founder and Director of the Alcohol Research Program at Loyola.
Dr. Kovacs is Professor and Director of Burn Research in the Division of GI, Trauma Additionally Dr. and Endocrine Surgery at Kovacs Laboratory Team: Devin Boe; Brenda Curtis, PhD; Kovacs was awarded Elizabeth Kovacs, PhD; Kevin Najarro & Lisbeth Boule, PhD the University of Colorado the Shock Society’s Denver. Research in the Society of Leukocyte Biology. highest honor the Scientific Kovacs laboratory focuses on She is on the Editorial Board Achievement Award for her the innate immunity. More of Cytokine, Alcohol, Journal eff orts in the fi eld. specifically, ongoing studies of Burn Care and Research, are examining how advanced and Shock. She was the Chair age and alcohol intoxication of the Committee on Public alter localized and systemic Affairs and has received the inflammatory responses Distinguished Service Award after injury or infection. Dr. from the American Association Kovacs has published over of Immunologists. In addition 200 manuscripts in diverse to serving as the Director of journals such as Journal of Burn Research, she is a Faculty Leukocyte Biology, Antioxidant Member in the Immunology and Redox Signaling, Graduate Program and the The American Journal of Medical Scientist Training Physiology, The Journal of the Program and a member of the Page 3
Richard D. Schulick; Ifran R. Qureshi; Camille Linick Stewart; Eduardo Gonzalez; Jeniann Aehui Yi; Zachary D. Hartman; Shannon N. Acker; Mary N. Carr; Sara C. Soule; Alessandro Paniccia; Lisa Sue Foley; Daine Thompson Bennett; Mark Nehler
CONGRATULATIONS DEPARTMENT OF SURGERY GRADUATES
Pediatric Surgery Fellowship
Thoracic Surgery Fellowship
Erica R. Gross, MD Pediatric Surgery Stony Brook University New York
Edward Bergeron, MD Faculty Munson Medical Center and Michigan State University College of Human Medicine Traverse City, Michigan
Pediatric Colorectal Fellowship
It is with much pride and appreciation that the Department of Surgery wishes our graduating residents and fellows much success in their continued training and careers!
General Surgery Residents
Cinthia Galvez, MD Research Fellow Boston Children’s Hospital
Shannon N. Acker, MD
Alessandro Paniccia, MD
Pediatric Surgery Fellowship Children’s Hospital Colorado
Surgical Oncology Fellowship University of Pittsburgh Pittsburgh, Pennsylvania
Daine Thompson Bennett, MD Colon & Rectal Surgery Fellowship Baylor University Medical Center Dallas, Texas
Mary N. Carr, MD Transplant Surgery Sydney, Australia
Lisa Sue Foley, MD Vascular Surgery Fellowship UT Southwestern Dallas, Texas
Eduardo Gonzalez, MD Plastic & Reconstructive Surgery Fellowship New York University New York, New York
Zachary D. Hartman, MD General Surgery Anchorage, Alaska
Irfan R. Qureshi, MD
Giorgio Zanotti, MD Indianapolis
Surgical Critical Care Fellowship
Critical Care Fellowship University of Iowa Iowa City, Iowa
Sara C. Soule, MD Trauma Director Private Hospital Nashville, Tennessee
Camille Linick Stewart, MD Surgical Oncology Fellowship City of Hope National Medical Center Duarte, California
Gregory Borst, MD Trauma and Acute Care Surgery Fellow University of Colorado
Lauren Steward, MD Assistant Professor University of Colorado
Jeniann Aehui Yi, MD Vascular Surgery Fellowship University of Colorado Aurora, Colorado
Stephanie Joyce, MD General Surgery Maine General Medical Center
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NEWS Transplant Surgery Fellowship
Trauma and Acute Care Surgery Fellowship
Megan Adams, MD Assistant Professor Transplant Surgery University of Colorado
Scott Moore, MD WakeMed Raleigh, North Carolina
Urology Chief Residents
Vascular Surgery Fellowship Beth Musser, Urology Residency Program Coordinator; Nicholas Westfall, MD; McCabe Kenny, MD; Randall B. Meacham, MD and Director, Urology Residency Program
Thomas J. Pshak, MD Assistant Professor Transplant Surgery University of Colorado
Greg Magee, MD Assistant Professor University of Southern California
Office of Education: Mark Nehler, MD; Michael Benge; Barbara Caufield; Claire Travis; Trina Smidt; Mary Kay Anderson; Kathleen O’Keefe; Richard D. Schulick, MD
Nicholas Westfall, MD The Urologic Associates of Western Colorado Grand Junction, Colorado
McCabe C. Kenny, MD Private Practice Des Moines, Iowa
Pediatric Urology Fellowship
Reconstructive Urology Fellowship
Alonso Carrasco, Jr., MD Faculty Children’s Mercy Hospital Kansas City, Missouri
Lisa M. Parrillo, MD Private Practice Boise, Idaho
The Department of Surgery greatly appreciates the efforts of the Office of Education and their work with our various residency programs and the coordination of the Graduation event. Thank you all for your hard work.
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Basic Science Research Presentations Mohamed Eldeiry, MD: The Role of ATP Dependent Potassium Channel in Spinal Cord Ischemic Protection Christina Kim, MD: Maturational Changes in Pulmonary Artery Endothelial Cell Function in vitro and Responsiveness to Insulin Growth Factor-1/Binding Protein 3 in the Developing Sheep Lung Patrick Kohtz, MD: Toll-like Receptor 4 is a Mediator of Proliferation of Esophageal Cancer and Mucosal Cells and is Upregulated in Response to Refllux-related Stimuli in vitro Hunter Moore, MD: Post-reperfusion Fibrinolysis During Liver Transplantation is Associated with Abnormal Citric Acid Cycle Metabolism and Circulating Succinate Depletion Georey Nunns, MD: Post-Traumatic Acute Lung Injury: The Role of Mitochondrial Metabolite Succinate
DEPARTMENT OF SURGERY 2017 ANNUAL RESEARCH SYMPOSIUM The Department of Surgery’s Annual Research Symposium is dedicated to the research performed by Residents, Fellows and Faculty over the past year. This year we were pleased to host Dr. Ronald V. Maier, MD. Dr. Maier is an accomplished trauma surgeon and scientist with a successful career in basic science. He demonstrates that a busy clinical surgeon can successfully direct and engage in basic science and
translational research, while holding major leadership positions. Twenty-six submissions for presentation were received this year. The sixteen selected speakers, to the right, represent the broad spectrum of basic/translational science and clinical/outcomes research being performed in the Department of Surgery. Below are this years award recipients.
Award Recipients The Eiseman Research Award in Basic Sciences Aline Rau, MD The Eiseman Research Award in Clinical Science Yihan Lin, MD The Ernest E. Moore Award in Basic Science Research Best Abstract Presentation Bradley Wallace, MD The Frederick L. Grover Award in Clinical Science Research Best Abstract Presentation Douglas Overbey, MD
Aline Rau, MD: Electronic Cigarettes are as Toxic to Skin Glap Survival as Tobacco Cigarettes Robert Torphy, MD: Tumor Stroma Density as a Biomarker in Pancreatic Cancer Bradley Wallace, MD: Anti-sFlt-1 Antibody Treatments Prevent Respiratory Disease in Experimental Bronchopulmonary Dysplasia
Clinical Research Presentations Alonso Carrasco, Jr., MD: Patterns of Care and Survival Comparison of Adult and Pediatric Wilms Tumor in the United States: A Study of the National Cancer Database Brandon Chapman, MD: Survival Outcomes Following Neoadjuvant FOLFIRINOX and Gemcitabine/Abraxane in Patients with Borderline Resectable and Locally Advanced Pancreatic Adenocarcinoma Scott Deeney, MD: Impact of Objective Echocardiographic Criteria for Timing of Congenital Diaphragmatic Hernia (CDH) Repair Maggie Hodges, MD: Pediatric Appendicitis: Is Referral to a Regional Pediatric Center Necessary? Yihan Lin, MD: Developing National Surgical, Obstetric and Anesthesia Plans - Experience in Zambia Douglas Overbey, MD: Combined Antibiotic and Mechanical Bowel Preparation is Associated with Lower Anastomotic Leak for all Types of Colectomy Thomas Pshak: Fibrinolytic Shutdown in Deceased Donors: A Potential Area to Improve Organ Function and Usability Camille Stewart: Evolving Trends Towards Minimally Invasive Surgery for Solid-Pseudopapillary Neoplasms
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NEWS H. JAMES FOX LECTURESHIP FUNDED BY THE H. JAMES FOX ENDOWMENT
Charles M. Balch, MD PhD
We were honored to host Dr. Charles M. Balch at our H. James Fox, MD Lectureship. His talk titled “Burnout of the American Surgeon: Understanding the Syndrome and Avoiding the Adverse Consequences was well received. Dr. Charles M. Balch has led a distinguished career as a clinical and academic surgical oncologist for the past 41 years, as a leading authority in both melanoma and breast cancer. He is author of over 740 publications, which have been cited over 24,000 times in the biomedical literature (h factor 74), and has lectured in over 42 different countries in the world and most of the major academic centers in the United States. Dr Balch is the founding Editor-inChief of the Annals of Surgical Oncology, which is recognized as the leading journal in the world in its field. He is also the Editor-in-Chief for Patient Resource Cancer Guides, which distributes over 1.3 million cancer guides (with 21 different titles) to cancer patients each year, plus two websites for cancer patient information: www.cancerresource.net
He had held major leadership roles involving clinical research in three comprehensive cancer centers (UAB, MD Anderson and City of Hope) prior to coming to Johns Hopkins from 2000 to 2010. He has also held leadership roles involving clinical research in cancer cooperative groups, NIH study sections, and in professional organizations. Dr. Balch’s leadership roles have involved the Society of Surgical Oncology (as President in 1992), where he currently serves as Editor-in-Chief for the society’s peer-reviewed journal, the Annals of Surgical Oncology; the American Board of Surgery (Board of Directors); the Association of Academic Surgeons (President); Commission on Cancer (Chair, Board of Directors); and the American Joint Committee on Cancer (Executive Committee). He was the EVP and CEO of the American Society of Clinical Oncology from 2000-2006, and on the full-time faculty at Johns Hopkins as Professor of Surgery, Oncology and Dermatology until 2011 when he joined the surgical oncology faculty at the University of Texas Southwestern Medical Center in Dallas, Texas. He recently rejoined the faculty of UT MD Anderson Cancer Center in Houston.
HONORS : : AWARDS : : ACCOMPLISHMENTS GME Recognizes Beth Musser Carol M. Rumack, MD, FACR the ACGME’s Designated Institutional Official (DIO) recently recognized Beth Musser, the Urology Residency Program Coordinator with a Special DIO Award. In addition, Beth was also recognized by the GME office as an Outstanding Program Coordinator. Dr. Rumack had this to say: “Beth has my respect as a highly credible and respected professional. Whether she realizes it or not, she consistently serves as our
key go-to Program Coordinator when GME is considering a new plan or process. Over the years, her Beth Musser, Urology thoughtful Residency Program deliberation Coordinator and collaboration has resulted in many improvements across GME...” Congratulations Beth, on this well deserved recognition.
Pediatric Surgical Critical Care Fellowship We are excited to announce that the ACGME application for establishment of a Pediatric Surgical Critical Care Fellowship program was approved in January. The
program director is Denis Bensard, M.D.. This is a oneyear training program and the first fellow, currently a chief resident at Emory University, will start on August 1, 2017.
Integrated Plastic Surgery Residency Program The Division of Plastic and Reconstructive Surgery is pleased to announce that we have received ACGME accreditation for a six year Integrated Plastic Surgery Residency Program. We offer 2 slots per year for a total of 12 residents when we reach our full compliment. We are very honored to welcome Jonathan Freedman, MD, Phd., and Colin McNamara, MD for the 20172018 academic year. Jonathan comes to us from Boston University SOM and Colin graduated from Oregon Health & Science University SOM and then served as a Flight Surgeon in the United States Navy.
Jonathan Freedman, MD, PhD
Colin McNamara, MD Page 7
CANCER SURGERY THROUGH “KEYHOLES” CAME AFTER A VERY LONG ROAD By: Todd Neff, for UCHealth
That Ken Littrell’s six-hour surgery to remove more than half his liver was done via a minimally invasive laparoscopic procedure is a remarkable thing. The fortitude it took the UCHealth University of Colorado Hospital surgeon to attain the skills to pull off such a feat makes it more amazing yet.
Mt. Democrat, 14,148’
SURGICAL MOUNTAIN ASCENT SERIES HIKE 5 MT. DEMOCRAT - 14, 148’ On Saturday, August 5th, the Department of Surgery will once again be leading a rugged team of dedicated alpinists up one of North America’s most beautiful and rewarding peaks. Please mark your calendars and join us for this annual celebration and high-altitude adventure! This year, we will be climbing Mt. Democrat, one of the most accessible and gorgeous peaks on the planet. Located in Colorado’s Mosquito Range and standing 14,148 ft. above sea level, Democrat is an easy climb (to the extent that anything above 14K feet can be considered easy) and is a great choice for both first-time climbers and veteran peak-baggers.
Mt. Democrat overlooks a beautiful alpine valley that surrounds Kite Lake, a pristine mountain reservoir located at 12,000 ft. The trail starts near the lake and climbs 2,154 feet to Democrats’ summit. To join this year’s hike simply email: shelly.lange@ucdenver.edu to sign up and obtain your waiver. More details will be available at: www.smash.cusurgery.com We hope you’ll join us.
Richard Schulick, MD & Randall Meacham, MD are always ready to hike
Littrell, 59, had already noted flagging energy levels when, walking out of the gym one day in September 2016, he couldn’t keep up with his wife Teresa, “and she had just had her knee replaced,” he said. The Parker resident soon had a stage 4 colon cancer diagnosis. In early October, Littrell had his ascending colon removed at a community hospital. But there was more work to be done. On a friend’s recommendation, he touched base with Christopher Lieu, MD, who directs the University of Colorado School of Medicine’s Colorectal Medical Oncology Program. Littrell’s case channeled into the GI Oncology Multidisciplinary Clinic, where a team of CU School of Medicine medical, radiation and surgical oncologists as well as radiologists and pathologists team up to craft care plans for tough cases like Littrell’s. Wells Messersmith, MD, took the lead, prescribing four rounds of chemotherapy, the goal being to shrink a threatening liver tumor to the point that surgeon Ana Gleisner, MD, PhD, could remove it.
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Career Change That Gleisner is a GI oncology surgeon at UCH – or anywhere else, for that matter – is a testament to just how much can change when talent meets drive. Gleisner had already gone through medical school, a three-year surgery residency,
Ana Gleisner, MD, PhD
a year of transplant-surgery fellowship and a PhD program. She was a practicing surgeon in her native Brazil. Her interest in medical research brought her to Johns Hopkins University, where she focused on surgical outcomes, co-authoring papers with, among others, Richard Schulick, MD, MBA, now Chair of the CU School of Medicine’s Department of Surgery. “I really fell in love with the oncology field,” Gleisner said. “It’s a team approach. That’s the only way you can get people to have the best outcomes – they’re complex decisions, and they require knowledge coming from several different fields, and I just loved having that kind of challenge and perspective.” She has continued her surgicaloutcomes research here, spearheading the development Page 8
NEWS of a database detailing hundreds of surgery cases, the aim being to spot ways to improve patient care. Into the Lap You might think a transplant surgeon could transition quickly to cancer surgery. In fact, it would take eight years. Gleisner would have to do a six-year surgical residency in the United States, then a two-year complex surgical oncology fellowship. She knew she would be again subjected to the grueling workloads such training involves. She did it anyway: the residency at Saint Louis University, the fellowship at the University of Pittsburgh Medical Center. When she finished in 2015, Schulick and Barish Edil, MD, helped bring her to Colorado, and, ultimately, to Ken Littrell.
liken it to preparing dinner through a couple of keyholes in the kitchen door. Some cases are too complex to do this way, but if it’s possible, there are big benefits: on average, there’s 50 percent less morbidity, 30 percent less blood loss, and two days less time in the hospital, among others, Gleisner said. In Littrell’s case, it was soon clear that one of the metastases was, as he put it, “really close to a major blood supply in the liver.” The team would have to remove 60 percent of the liver, Gleisner concluded. They would start laparoscopically, reserving the option of switching to open surgery midstream if she deemed it necessary. “She made me feel real comfortable and was a real straight shooter. She laid out
In Pittsburgh, Gleisner had honed rare skills in major laparoscopic cancer surgery on the liver. Having been involved with many liver transplants and other open liver surgeries was an advantage, she said. Successful laparoscopy – in Teresa and Ken Littrell which the work is done through small incisions, all the options and said, ‘This guided by a camera on one surgery is the best chance for probe and surgical instruments a cure,’” Littrell said. “Nobody on others – demands a had ever used the word ‘cure’ deep understanding of with me.” the underlying anatomy Gleisner is careful to balance and experience with open procedures, she said. You might the benefits of minimally
invasive surgery with the overarching goal of removing any visible hint of cancer, she said, “because you can’t compromise the oncologic safety and outcomes because of the approach.” In simple terms, just because you can wield the hammer of laparoscopy does not make every GI cancer surgery a nail.” “Having the ability to do any procedure laparoscopic, open, or a combination of the two gives patients the most options,” Schulick explained. Back in business She performed the surgery on Feb. 8. It went well, Littrell said. Gleisner visited him daily in the surgical intensive care unit and then the inpatient oncology unit at UCH. He was back home eight days later. Two-and-a-half weeks after the surgery, Littrell was working part-time from home as a senior software engineer. A few days after that, he was in the office part-time – a quick return made possible in part, he said, by the small incisions involved in laparoscopy. His energy was slow in returning – not because of the cancer this time, but because his body was preoccupied with re-growing the bulk of his liver, which took about two months. Edil, himself a surgeon with rare laparoscopic expertise and one of few in the United States capable of doing a laparoscopic Whipple procedure for pancreatic cancer patients, called the surgery, “one of the
toughest liver operations to be done laparoscopically. It’s a huge feat for our program and our hospital.” Littrell’s cancer care continues under Messersmith’s watch, in the form of follow-on chemotherapy to take out remnant cancer cells no surgeon can see. Both are hopeful that the term “cure” will indeed apply. In addition to Gleisner’s surgical skills, Littrell said he appreciates how invested she was in his well-being. “She’s just so caring and really took the time to engage with me on how I was feeling,” he said. “She was really great, and I think she’s a wonderful person.”
CLICK HERE For information about the Cancer Center
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able to feel the pain of the wound. Treatment can involve infectious disease experts, pathologists, radiologists, podiatrists, surgeons, vascular experts, nutritionists, physical and occupational therapists and others.
Martha Milkey
THE VILLAIN: A CARDBOARD BOX
By: Todd Neff, for UCHealth
The villain, in Martha Milkey’s case, wasn’t terribly fearsome: a cardboard box just inside the doorway to her bedroom. She had walked past it before, but one day in early December 2016, she caught it with her lower shin and it opened up a cut about the size a quarter. She and her brother John Darrow, who shares a home with her in Denver, washed it out and bandaged it up. They figured she’d be fine. A couple of days later, on Dec. 13, Milkey, 75, found herself at UCHealth University of Colorado Hospital, where staff there treated a wound that had gotten infected and spread across a two-inch by four-inch swath of her left ankle. They drained it, cleaned it and put her on intravenous antibiotics. The wound was slow to heal and Milkey became very worried. Ultimately, her primary care physician, Corey Lyon, DO, of UCHealth’s A.F. Williams Family Medicine Center in Denver’s Stapleton neighborhood, referred Milkey to his CU School of Medicine
colleague Robert Carson, MD, medical director of UCH’s Outpatient Wound Care and Ostomy Clinic. Carson is an internal medicine specialist who had arrived at UCH in February 2016. He brought deep expertise in wound care and a desire to streamline and expand the hospital’s work to heal wounds into a formal Wound Care Program. Milkey would be one of that program’s beneficiaries. UCH has been doing wound care since the hospital opened its doors in 1885. But doing wound care right in the 21st century takes an array of experts and resources. That’s a reflection of the wide variety of wound types and the diversity of care approaches their care can involve. There are wounds from accidents, from postsurgical complications, from cancers, from autoimmune disorders, from diabetes, and, yes, from cardboard boxes. Patients often have other health issues: for example, those with pressure wounds (bedsores) may be paraplegic, malnourished, or not be
“We want to be consulting with appropriate specialties to make sure we’re providing well-rounded care for what are almost always multifaceted problems,” Carson said. He pulled these experts into an in-house referral network. Two full-time wound-certified nurses joined the team, too, as did two dedicated medical assistants, and, starting in February, Shelley Brake, PA, a full-time physician assistant specializing in wound care.
“We want to get them in as quickly as possible and get care started,” he said. When Darrow wheeled Milkey into a UCH Anschutz Outpatient Pavilion Wound Clinic exam room in late December, Carson debrided (cleaned) the wound, assessed her vascular status, took cultures for testing, and made sure she had the appropriate dressings. But he also took care of her worries. “He was so pleasant, so encouraging and so compassionate. He said, ‘It’s going to be OK, it’s not going to be amputation, it’s not going to be death,’” Milkey recalled. “He changed my mood …”
It’s made a big difference in the number of wound patients the hospital can handle: In November 2015, Shelley Brake, PA-C and Robert Carson, MD they managed 78 appointments. A year later, By Jan.13, she had progressed it was 221 appointments. Wait enough to return home. At times have dropped from 18 her March 14 appointment, days in December 2015 to a the wound had shrunk to the week and often less today. With size of a nickel and had all but wound care, seeing patients completely sealed. Carson said quickly is important, Carson he was “thrilled” with said, because physicians in the her progress. community often lack training “I don’t think she could have in would care and confidence healed any faster than she’s in managing these healed,” he said. “I think every sorts of patients. thing’s fallen into place for her.”
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NEWS DENVER MAN HAS WARNING FOR OTHERS AFTER E-CIGARETTE BATTERY EXPLODES By: Mark Boyle, for Denver 7
It’s been a very long week for Gregory Ingram and his family. Ingram has spent a week at the Burn Intensive Care Unit at University of Colorado Hospital and a week away from his two young children following Christmas.
“Be extremely cautious or if not just don’t use them at all. It’s very dangerous,” said Ingram.
Burn experts say more and more people are getting hurt like this at an alarming rate.
“A lot of people have turned to e-cigarettes as perhaps a
According to the University of Colorado Hospital, 15 people have been treated for burns stemming from e-cigarettes in 2016. That’s compared to two people treated for the same injury in 2015, and none reported at the hospital in 2014. A hospital spokesperson told Denver7 they didn’t track these types of burns before 2014 because they were so rare.
“We were supposed to get my oldest a fish for the fish tank that Santa brought this week; I haven’t been able to do that. We were supposed Gregory Ingram’s burned pocket/pant leg. to play with all of the (Photo by: Mark Boyle) presents; I haven’t been able to do that either,” safer method of smoking, but said Ingram. cigarettes don’t explode in Ingram said as he was going to work on Dec. 26 when the battery of his e-cigarette blew up in his pocket without any warning. Unlike many reported e-cigarette battery explosions, there wasn’t anything else in the pocket with the battery at the time of the accident, said Ingram “My pants caught on fire and the flames shot out and got my thumb, and then I went to try to pat that out and then my whole pocket just erupted,” said Ingram. Now, second and third-degree burns cover Ingram’s upper leg and hands, leaving a permanent reminder of the accident and also leaving him and his burn surgeon with one message to others:
your pocket, so it actually turns out to be not a safer method of smoking, and we still don’t know the effects on the lungs,” said Dr. Arek Wiktor, who’s a burn and trauma surgeon at University of Colorado Hospital in Aurora. “Beware, because we really don’t know what’s causing this. We really don’t know how to prevent it, and I really hate to see people come into our ICU one or two a month with these explosions and I can’t really tell them why or not, I guess the key is don’t smoke.” Ingram isn’t the only one who has had this happen.
BURN CLINIC PROVIDERS
Camy Bell, MS
Dr. Wiktor said, fortunately, the e-cigarette burn injuries they see cover five to seven percent of the patient’s body, which is small. Meanwhile, Ingram is just glad his injury wasn’t worse, and he can still walk out of the hospital just days after his accident.
Anne Wagner, MD
Dr. Wiktor notes that the burn unit at the University of Colorado Hospital is the only American Burn Association verified burn center in Colorado and our broader fivestate region. Arek Wiktor, MD
Dr. Arek Wiktor looks over Gregory Ingram’s burned leg. (Photo by: Mark Boyle)
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Thomas Bak, MD, performed the donor surgery; Kendra Conzen, MD, performed the recipient surgery; Jennifer Lee, Maryam Ornelas, Ryan Davis, and Jim Frederick. Lee and Frederick were donors; Ornelas and Davis Recipients.
ALTRUISTIC DONOR TRIGGERS FIRST TRANSPACIFIC PAIRED KIDNEY EXCHANGE By: Todd Neff, for UCHealth
It started with a pod cast. It ended with three live-donor kidney transplants among complete strangers, two of them involving the flight of vital organs halfway across the Pacific Ocean – a first. On the first day of spring, the six people involved were together for the first time, live and via video-conference. Four were at UCHealth University of Colorado Hospital; the other two were 3,300 miles away, at the Queen’s Medical Center in Honolulu, Hawaii. Jim Fredrick, 54, listened to the pod cast in June 2015. The Colorado Springs man tuned in to a Freakonomics Radio episode focusing on problems money alone can’t solve, with organ transplant being a central example. “I got intrigued,” Fredrick said. Then in February 2016, Fredrick caught another Freakonomics Radio pod cast. It featured a Connecticut man who had
listened to that same June 2015 pod cast and then donated a kidney to a complete stranger – an altruistic kidney donation, it’s called. “When I listened to that one, it hit me like a ton of bricks,” Fredrick recalled. “And I said, ‘I think I can do that.’” He reached out to the UCHealth University of Colorado Hospital Transplant Center. Angela Miskolci, RN, a transplant coordinator, took the case. Of the roughly 140 kidney transplants the UCH Transplant Center did in the past year, three involved altruistic donors. Thanks to something called paired kidney exchange, those donors can save more than a single life, triggering a cascade of beneficence that works like this. The big swap The altruistic donor offers to give her kidney to anyone whose physical dimensions, blood type, age and immune
system will allow it. The nonprofit National Kidney Registry takes that information and taps into its paired kidney donation database. The database contains pairs of people. One of them needs a kidney transplant. The other would like to donate a kidney to the first person – but can’t do it because she’s not a compatible donor. So the healthy person agrees to donate a kidney to someone she doesn’t know in exchange for their friend or loved one’s receiving a kidney from someone he doesn’t know.
match for Maryam Ornelas, 50, of Aurora. She had been diagnosed with cancer in 2014, and the cancer had ruined her kidneys. She had been on dialysis ever since. Jennifer Lee, also of Aurora, volunteered as a paired donor. Lee, 44, said she would have preferred to give a kidney to Ornelas, but they were incompatible. When approached about paired donations, she said, she accepted because “not only could I help her, I could help someone else.” Theirs was not your typical organ donor-recipient relationship in another way.
Why do all this juggling? As of late March, nearly “This is my husband’s ex-wife,” 98,000 people were on the Lee told those gathered for the national waiting list for a video-conference. “So that’s kidney, according to the a little unique twist there.” Organ Procurement and They’ve been friends for a Transplantation Network (OPTN). They wait, on average, decade, Lee continued, “and she has graciously allowed me four to seven years. That’s a to co-raise my stepdaughter for long wait for anything, and the last 22 years.” longer yet when one must endure fourhour dialysis sessions three times a week the entire time. Kidney transplant patients who can arrange for a live donor can avoid the virtual line. That’s also the Teleconference with the Hawaiian side of the trans-Pacific case with paired donation on Monday, March 20, 2017. paired donors. But often, it takes someone like Jim Fredrick to set things in motion. And in this case, that chain stretched from Aurora to Honolulu. Pair up Fredrick’s kidney was a
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Lee turned out to be a match for Cherish Matauria, 24, a mother of three young children in Honolulu. Matauria was already on dialysis in 2015 when Elizabeth Lehman, a nurse at the Honolulu pediatrics office Page 12
NEWS where Matauria takes her kids, “saw how hard it was to manage her kids and dialysis and full-time work,” Lehman said. Matauria wasn’t quite sure what to make of it at first. “Out of the blue she texted me one day and said, ‘I want to donate my kidney to you,’” Matauria said. “I thought she was joking but it turns out she really did want to help.” Lehman and Matauria were also incompatible, but Lehman’s kidney was a match for Ryan Davis, 37, of Elizabeth, Colorado A martial arts instructor with two girls and a boy now ages 10, eight and four, Davis’s combination of diabetes and complications from foot surgery led to kidney failure, he said. “I was doing dialysis three nights a week, I was working three jobs and trying to home school three kids,” Davis recalled. “I had promised my wife I would walk my girls down the aisle. I wasn’t allowed to pass before them.” Lots of prep And so the stage was set. What remained was a great deal of preparing and arranging at sea level and a mile above it. In the two weeks prior to the transplant, Miskolci and Maile Reddy, her Queen’s Medical Center counterpart, communicated “sometimes 10 times a day,” Miskolci said. Being part of the National Kidney Registry made things easier. This paired exchange program, the largest in the country, matches incompatible
pairs and sends out offers for en route to Colorado, where, exchanges. They put transplant at 6 a.m. on Nov. 16, Conzen coordinators in touch with transplanted it into Davis, each other and handled the completing the swap. details related to the DenverNew lives Honolulu and HonoluluDenver transportation. Kidneys Four months later, as they fly commercial, and in this convened physically and case, it was important they had direct flights – they must be transplanted within 24 hours of removal, and the sooner the better. United Airlines’ nonstop from Denver to Honolulu takes seven-andJennifer Lee; Mayam Ornales, Ryan Davis and Jim Fredrick. a-half hours, with the reverse about an hour virtually, they were all doing shorter, thanks to the jet stream. well. They told their stories A backup flight with one stop briefly. The prevailing vibe was was arranged just in case. a mix of nervousness, gratitude and amazement. University of “This was unique in the simple fact that it was going across the Colorado surgeons Bak and Conzen sat in, too, though, as ocean so we had to make sure Bak put it, “We just take ‘em we made our flights,” out and put ‘em in – these guys Miskolci said. are the stories.” The team at UCH also lined “I just appreciate everyone in up the transplant surgeons: this chain and hope it continues Thomas Bak, MD, would do to raise awareness about paired the surgeries on the Colorado exchange,” Conzen said. donors Fredrick and Lee; “Thank you to all of you.” Kendra Conzen, MD, would transplant the kidneys into Asked what their worries had Ornelas and Davis. been, the paired donors Lee and Lehman said their primary On Nov. 14, 2016, they did concern that Ornelas and the UCH in-house surgeries, transplanting Fredrick’s kidney Matauria would reject the new kidneys. into Ornelas. The next day, Bak removed Lee’s kidney “And of course I’d be lying if I in time for a midday flight; it said I wasn’t afraid to give up arrived in time for Matauria’s an organ and what that meant,” procedure, which started at 5 Lee said. “But I think all of the p.m. in Honolulu. Edwards’ questions I had throughout the kidney, having been removed process were answered, and four hours earlier, was already
my fears were put to rest along the way.” For the recipients, it’s been lifechanging. “I feel much better – just not having to do dialysis,” Ornelas said. “Now I can focus on the things that are really important,” Davis said. “And that’s such a blessing I can’t even define it.” “Whenever I went to dialysis, my kids would always cry and ask me to stay home with them,” Matauria said, her voice breaking. “And now that I have a new kidney, it gives me more time to be with them and watch them grow.” Fredrick, who set it all in motion with his altruistic donation, said he was back climbing the Manitou Incline three weeks after the surgery. The incision’s healing still kept him from doing sit-ups and such, he said, but he had changed his diet before the surgery, had lost seven pounds and felt better than ever. “And you recognize you’re just a happier person when you’ve donated an organ voluntarily,” he added. “Most people think: ‘What?’ They don’t get it. Which is fine – I don’t need anybody else to get it. People that do it get it.”
CLICK HERE For more information on altruistic kidney donation.
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FOR THIS COUPLE, GAINS CAME FROM LOSS By: Tyler Smith, UCHealth
A third of U.S. first-year college students intending to study STEM are underrepresented minorities (green). But only one-sixth of STEM baccalaureate degree recipients (turquoise) and one-tenth of STEM PhDs (blue) are underrepresented minorities.
MILLION DOLLAR GRANT ENCOURAGES DIVERSITY IN STEM PROGRAMS Emily Williams, University Communications
The University of Colorado Denver has been awarded $1 million in funding from the Howard Hughes Medical Institute (HHMI) to improve learning outcomes for underrepresented first and second year college students studying science. Part of HHMI’s Inclusive Excellence initiative, the grant will be used to improve Biology instruction and curriculum by incorporating more active learning opportunities and research experiences into introductory Biology classes. CU Denver is one of 24 higher education institutions awarded the 2017 Inclusive Excellence grant; over 500 colleges and universities applied. Using grant funds, CU Denver will provide faculty with more professional development opportunities around inclusive teaching practices and identifying and removing barriers faced by underrepresented students, particularly in science fields. Student advising practices will also be updated using a proactive and data informed approach...
“Our goal is to increase student success and reduce the equity gap in our general Biology classes,” said Rich Allen, Associate Dean for Teaching, Learning, and Curriculum in the College of Liberal Arts and Sciences and Program Director on the award. “Ultimately, we aim to provide more experiences that help our students develop confidence, motivation, knowledge, a sense of belonging, and an identity as scientists.” The HHMI Inclusive Excellence initiative is designed to help colleges and universities encourage participation and cultivate the talent of students in the natural sciences. Grant applicants were challenged to identify the reasons students are excluded from science and find new ways to include students in opportunities to achieve science excellence. In particular, the HHMI initiative focuses on those undergraduates who come to college from diverse backgrounds and pathways... CLICK HERE To read the complete Article
Sit down with Diane and Dan Hopmann and there’s a sense of completeness. The Aurora couple have been married 42 years with two grown kids and grandsons ages two and five. He works as an IT manager at Visa; she has a home-based business selling LuLaRoe clothing. He possesses a dry wit; her soft-spoken sincerity complements it. These are good people, the kind other people just feel comfortable being around. But as with any pair having spent 64 years on this Earth, there has been loss, too. In the case of the Hopmanns, one loss led to another which, in turn, has brought them immense rewards, both anticipated and otherwise.
Both were thin when they were younger - Dan even described himself as having been “a beanpole in high school and college.” But, as he put it, “You start in the workaday world flying a desk eight hours a day and it packs on after a while.” By 2015, neither moved well. They loved the mountains, but Diane was short of breath at altitude. Dan couldn’t make it up the four floors of stairs to his office without stopping to pant. They had a harder time keeping up with their young grandsons than they imagined they might. Both were pre-diabetic and had high blood pressure. Dan had restless leg syndrome. Their sleep apnea meant continuous positive airway pressure (CPAP) machines at night.
The triggering loss was of Diane’s brother, who died of pancreatic cancer in May 2015. She called it a family tragedy.
They knew that losing weight would help, and they tried many times. Diane recalled going on a 500-calorie-a-day diet at one point, which is “My brother was taking care of ample sustenance only if you himself,” Diane said. “I was the happen to be a hamster. They obese sibling.” knew of bariatric surgery, but Dan was didn’t know similarly struck. insurance companies “It just reminded backed it. Their us of the primary care value and the doctors Katie preciousness of Suddarth, what we had MD (Diane), and the desire to and Laurence make it better,” Williams, MD he said. (Dan), and their Diane was fiveother health care Diane and Dan Hopmann at UCH foot-two and providers were for their one-year checkup after bariatric surgery. Dan has lost 114 weighed 263 at University pounds, Diane 104. Those pants pounds at the of Colorado don’t quite fit anymore. time. Dan was Hospital, making a goot taller and weighed 330. the Surgical Weight Loss Center
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NEWS the obvious choice for weight loss procedures.
procedure can be called a tool is a testament to the importance of the ecosystem of Surgical Weight Loss Center support surrounding the surgery itself, including support group meetings, exercise programs, dietary and psychological counseling and medical visits. That support goes on “forever,” as dietician Lisa Kassel, RD, CNSC, put it.
In summer 2015, they started the process by attending an information session led by Jonathan Schoen, MD, who with fellow University of Colorado School of Medicine surgeon Kevin Rothchild, MD, performs the center’s bariatric surgeries. Their insurance company gave the go-ahead provided they start the bariatric diet The vertical sleeve gastrectomy, which (high protein, the Hopmann’s had three weeks apart, low carb) removed about 85 percent of their stomand lose achs. It’s an irreversible process, and that weight before was part of the appeal. “I didn’t want to leave myself with an escape hatch,” Dan the surgery.
“The preparation and the follow-up are critical,” Dan added.
Diane’s surgery happened first, in late October 2015, with Dan following three said. ”I didn’t want a way out. weeks later. There’s also a psychological Diane’s recovery from the evaluation. The point isn’t to laparoscopic procedure went slim down or determine sanity more quickly, in part because so much as to demonstrate that Schoen had to deal with the bariatric surgery candidate scarring from a gallbladder has the stability and willpower surgery Dan had done 20 to ensure the surgery’s longyears ago. term success - which is far For both, there were weeks of from guaranteed. adjustment - from consuming “The surgery is a tool,” Dan only clear liquids before said, repeating the center’s advancing to full liquids to guiding mantra. purees to soft foods. An indepth preoperative nutrition That tool, in the Hopmann’s class prior to surgery and a case, would be a vertical sleeve detailed nutrition book from gastrectomy. This involves the center provided guidance. removing more than half the stomach, leaving not much “You go through a lot of more than an esophagusyogurt,” Dan said. width pouch and a slew of They avoided complications staples behind. That such associated with bariatric a major - and irreversible surgery and they started
living a different dietary life. Breakfast consists of protein shakes. Carbohydrates largely disappeared from the house, and pasta ad pizza are indulgences of the past as is Diane’s swooning for McDonald’s fast food. She said she doesn’t crave it, or carb-heavy foods in general, anymore. A carb splurge, she said, might come in the form of a small piece of birthday cake, a thin slice of pie or a dinner roll. Dan admits to a lingering weakness for oatmeal raisin cookies, but comes across one rarely. She and Dan continue to eat out. But they exercise portion control to the point that they tend to get two additional meals out of their doggie bags. They take “bariatric vitamins” three or four times a day to counteract the lessened absorption in the stomach. Their alcohol tolerance is way down. “We make for a really cheap date night,” Dan said.
assistant, did the honors. Brave said that even from her seasoned perspective, the changes are “amazing to see, especially when we have patients who have lost 300, 400 pounds. They’re unrecognizable.”... The average bariatric patient loses 60 percent of his or her excess weight. Diane had lost 75 percent of hers; Dan 70 percent of his. Schoen did some calculations and concluded that, if they wanted to, he would sanction either of them losing a few pounds more. But from a medical perspective, they were already in good shape... They will be back in six months. Until then, they plan to come in for monthly support group meetings...
Diane Hopmann talks with Jonathan Schoen, MD, as Diane’s husband Dan looks on during their appointment a year after bariatric surgery, which Schoen performed. Both lost more than 100 pounds
On Nov. 30, just over a year after their surgeries, they were on the sixth floor of the Anschutz Outpatient Pavilion for their one-year post-surgical appointment. It started with a weigh-in and, a bit later, a waistline check. Jamie Brave, the center’s senior medical
CLICK HERE To read the complete UCH Insider Article
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UPCOMING EVENTS
July 10, 2017
July 17, 2017
July 24, 2017
Core Curriculum 7:00 am - 8:00 am Thoracic I & II Michael Weyant, MD Associate Professor, CT UCHealth
Core Curriculum 7:00 am - 8:00 am
July 31, 2017 Core Curriculum 7:00 am - 8:00 am
Thoracic III & IV John Mitchell, MD Professor, CT UCHealth
Thoracic Procedures Robert Meguid, MD, MPH Assistant Professor, CT UCHealth Surgical Education Grand Rounds
August 5, 2017
August 7, 2017
August 14, 2017
SMASH 5 Mt. Democrat Hike
Core Curriculum 7:00 am - 8:00 am Urology II Brian Caldwell, MD Assistant Professor, Urology UCHealth
RSVP: shelly.lange@ucdenver.edu
August 28, 2017
September 4, 2017
Breast II & III - Malignant Disease Colleen Murphy, MD Asst. Professor, Surgical Oncology Lone Tree Breast Center UCHealth
September 25, 2017 Grand Rounds 6:30 am - 8:00 am The Open Abdomen Clay Cothren Burlew, MD Professor, GITES Denver Health Biliary Atresia: Past, Present, & Future Jon Roach, MD Asst. Professor, Pediatric Surgery Children’s Hospital Colorado
No Conferences
Holiday Labor Day
October 2, 2017 Grand Rounds 6:30 am - 8:00 am Wide Awake Hand Surgery in Colorado Ashley Ignatiuk, MD Assistant Professor Plastic & Reconstructive Surgery UCHealth Assessments Mark Nehler, MD Professor, Vascular Surgery UCHealth
Urology I Ty Higuchi, MD, PhD Assistant Professor, Urology UCHealth
August 21, 2017 Core Curriculum 7:00 am - 8:00 am
Transplant I & II Trevor Nydam, MD Associate Professor, Transplant UCHealth
Gynecology Jamie Arruda, MD Associate Professor, Ob/Gyn UCHealth
Core Curriculum 7:00 am - 8:00 am
Core Curriculum 7:00 am - 8:00 am
Core Curriculum 7:00 am - 8:00 am Transplant III Trevor Nydam, MD Associate Professor, Transplant UCHealth Breast I - Benign Disease Nicole Kounalakis, MD Asst. Professor, Surgical Oncology UCHealth
September 11, 2017 John & Cynthia Schultz Lectureship 6:30 am - 8:00 am
September 18, 2017 Combined Grand Rounds 6:30 am - 8:00 am
Laparoscopic Cholecystectomy: Still Room for Improvement L. Michael Brunt, MD Washington University, SOM in St. Louis Professor of Surgery
Design and Management of a Regional ECMO Program Jack Gutsche, MD University of Pennsylvania
October 9, 2017
October 16, 2017 Grand Rounds 6:30 am - 8:00 am
Grand Rounds 6:30 am - 8:00 am
NSQIP Update Robert Meguid, MD, MPH Assistant Professor, CT UCHealth
To Be Announced James Pomposelli, MD, PhD Professor, Transplant UCHealth
Strategies for Sarcoma Management Martin McCarter, MD Professor, Surgical Oncology UCHealth
To Be Announced Teresa Jones, MD Assistant Professor, GITES VA Eastern Colorado
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